When Teenagers need Antidepressants

In the summer of 1980, I was 19 years old and had a defining panic attack that divided my life into a very clear before and after. No one could explain what was happening to me. Was I having a heart attack? Was a tumor pressing down on my thyroid? I could only hope. During one particularly long jag of crying and rocking myself back and forth for hours, my parents took me to the emergency room. The doctor prescribed sleeping pills and told me to “get a hold of myself.”

No one suggested that there could be a physical condition underlying my anxiety and depression — at least, not to me. The research that shows that anxiety and depression can be treatable conditions caused by a chemical imbalance in the brain — chronic illnesses that respond to medication like high cholesterol or diabetes — was not widely known. Instead, I confused my brain’s failure with individual failure.

Because of all we have learned about the use of selective serotonin reuptake inhibitors (S.S.R.I.’s) in the last two decades, this first generation of young adults who have come of age on psychotropic medications doesn’t have to be burdened with the idea that their anxiety and depression is a personal flaw or weakness. The result is that some young adults who have been treated since their teens find themselves questioning the distinction, and the status of depression and anxiety as treatable medical conditions rather than emotional states. Their questions — loudly publicized in a world very willing to consider depression as nothing more than weakness — may cause parents to turn away from medications that could help their own teenagers.

After symptoms have abated, it’s natural to wonder if a depression could have been similarly worked through with just talk therapy. But that’s a chance I don’t think a parent should take with a child in a prolonged crisis. Speaking from my own teenage experience, my long-term suffering would have been considerably lessened had my anxiety and depression been treated as a medical condition rather than a shortcoming.

Writing for The Wall Street Journal, Katherine Sharpe, who began medication at 17, but tapered off her Zoloft for the final time a decade later, says:

Using antidepressants when you’re young raises tough questions of personal identity. Adults who take these drugs often report that the pills turn them back into the people they were before depression obscured their true selves. But for adolescents whose identity is still under construction, the picture is more complex. Lacking a reliable conception of what it is to feel ‘like themselves,’ young people have no way to gauge the effects of the drugs on their developing personalities.

Ms. Sharpe’s new book, “Coming of Age on Zoloft,” expands on those ideas. She suggests that comparing anxiety and depression to chronic physical illnesses is a weak tactic to remove the stigma around taking psychotropic medications — a marketing ploy of pharmaceutical companies. “The phrase ‘chemical imbalance’ sounds great. It conveys a sense of crisp scientific certainty, the promise of detailed technical knowledge about what depression really is. But despite the phrase’s appeal, and its ubiquity, the impression that it gives of open-and-shut understanding is misleading. A scientific model is only as good as how well it accounts for facts, and by that measure, our biomedical model of depression is neither fully complete nor unassailable.”

I understand that psychotropic drugs are controversial for what they can and cannot do. I’ve had my good days and bad days on them. But parents need to go beyond hyperbole to reconcile that sometimes medicine is the right choice, maybe the only choice, to lift a child’s depression. These medications are not a relatively quick fix like antibiotics. It takes commitment and, yes, resolve to take an S.S.R.I. There is also the dark possibility that these medications can engender suicidal thoughts in people, particularly those under the age of 25. Those are risks that need to be weighed against the very real risks of untreated depression.

Ms. Sharpe is particularly critical of the view that psychotropic medications are often prescribed too hastily. I’m with her on this point. She’s a strong advocate of talk therapy in conjunction with medication. So am I. The psychiatrist at her college health center “sent me away a few minutes later with a prescription and a generous supply of small cardboard boxes full of beautiful blue pills, free samples dropped off on campus by a company rep. The [psychiatrist] didn’t suggest talk therapy. She simply asked that I return for a ‘med check’ every few weeks to make sure that the pills were working.” Ms. Sharpe is right to condemn such treatment. It takes more than a 20-minute appointment to determine if a depressive episode is situational or more serious.

Still, Ms. Sharpe’s cautionary tale should not scare parents off of considering psychotropic medication for a child who needs it. Parents who choose the psychopharmacological route for their children should be prepared to square off with them down the road as they weigh the decision to continue on medication as adults or end it. But questioning the decisions your parents made for you as a child in your own adulthood is a side effect of growing up, not of taking S.S.R.I.’s.

I’m a believer — steadfast really — in using all the resources at hand to help kids through debilitating depression and anxiety. Maybe it’s because I remember a time when emotional equilibrium was not so readily achieved